There are an increasing opportunities for graduates of occupational therapy schools, especially those who want to specialize in a specific area, such as working with elderly patients, schoolchildren, or individuals recovering from brain and spinal injuries. There are more than 104,000 licensed occupational therapists in the United States; the largest percentage (29 percent) work in ambulatory health care services. By 2018, the Bureau of Labor Statistics anticipates that there will be nearly 50,000 new positions available.
Although potential earnings vary by location and practice, the average annual income for the lowest-earning graduates from occupational therapy schools in 2010 was around $62,000, while the highest-paid earned $85,000 or more. Most practitioners earned between $67,000 and $79,000 in 2010, although the median was $78,000. At the low end of the earnings spectrum, therapists working at correctional facilities made the least, averaging $58,000, while those involved in allied health organizations earned the most—on average $103,000. Home health care services paid an average of $79,110, while the employment services industry average was $78,630. Occupational therapists working at schools received an average annual salary of $75,260, while those at nursing homes averaged around $73,200, and those in physician’s offices earned an average of $71,840.
Occupational therapists in hospitals and other health care and community settings usually work a 40-hour week. Those working in schools are also required to attend meetings and participate in other activities during and after normal school hours, and this can take more time. One in three occupational therapists work part time, while others serve as consultants to health maintenance organizations, schools, correctional systems, large private employers, and individual medical practitioners.
Very few graduates of occupational therapy schools enter private practice, but the number is growing, and those who do tend to contract their services to schools, health care agencies, adult day care programs, and nursing homes. Providing hand therapy, for example, has become the most popular area of private occupational therapy practice. Many occupational therapists in private practice partner with physical therapists to share resources and expertise, reduce expenses, and provide complementary services. Insurance companies, HMOs, IPAs, and TPAs are increasingly utilizing such joint partnerships. Operating a private practice can be a very daunting experience; just dealing with workers compensation insurance can be nearly a full time job in itself. This is one reason most therapists don’t choose the self-employment route.
For graduates of occupational therapy schools who do choose to enter private practice, another of the most difficult, frustrating, and time-consuming aspects is developing contacts for referrals and dealing with billing paperwork.
Payment from private insurers or Medicaid or Medicare requires a thorough knowledge of billing codes for services rendered, and mastering these current procedural terminology (CPT) codes is a challenge. Although classes are available, it is often easier to hire a part-time billing assistant or a firm specializing in medical billing.
Knowing how to market, advertise, and promote your services is another consideration. Fortunately, the small number of occupational therapy practices in most areas makes this easier than for, say, physical therapy services. While advertising in local media can help increase awareness of your practice, unlike direct referrals, it tends to be expensive. Meeting colleagues in the health care and medical community is the best way to advance a private practice, as is volunteering at area hospitals and clinics.
Because the number of private practitioners is small, income data is not available from the Bureau of Labor Statistics, American Occupational Therapy Association (AOTA), or other sources. Nonetheless, as with any private health care practice, earnings are directly correlated to the number of patients treated, the severity of the condition being treated, and the frequency that services are required.
There are also ethical considerations involved in private practice, according to the AOTA. “In private practice, clinicians are generally more directly involved with and affected by organizational aspects and ethical issues related to business practices,” the group stated in a special advisory to members.
“Practitioners, whether owners or employees, need to understand that business stability and predictability of referrals are important; however, these must be balanced against their possible influence on clinical care,” according to the group. “Whether working in independent practice or in a physician’s office, the burden is on practitioners to ensure that they are making clinical decisions that are in compliance with core ethical principles related to benefiting the consumer or patient.”
Graduates of occupational therapy schools who are employed by rehabilitation centers typically work a full-time schedule, helping patients with a range of disabilities. Such centers usually have a full range of rehabilitation equipment and computer tools to assist treatment, and patients are usually seen frequently and on a regular schedule so it is easier to establish close relationships and better track their progress. This can be more difficult with patients who live at home, where the influence of other family members and other factors can present barriers to effective therapy.
On the downside, many rehabilitation centers often set specific benchmarks for patient progress that do not fully take into consideration the uniqueness of each patient, the disability, or the patient’s ability to make steady improvement.
Occupational therapists generally see patients of most ages, although the elderly make up a larger proportion. Impairments can include orthopedic and work-related injuries, the effects of stroke and normal aging, arthritis and chronic pain, and recovery from auto accidents. Based on each occupational therapy plan, rehabilitation typically includes training to help a patient with daily living tasks; therapeutic exercises or activities; muscle, leg, arm, and hand therapy; as well as cognitive exercises.
During the initial workup, the occupational therapist evaluates a patient’s disability and degree of impairment and establishes realistic treatment goals.
State-of-the-art rehabilitation equipment and intervention software are typically used to allow patients to perform highly defined movements and exercises that can be carefully measured to gauge progress over time.
Although patients whose functional abilities are expected to improve are the traditional candidates for occupational therapy, such care is increasingly becoming an essential component of hospice and palliative treatment for those with terminal illnesses.
The loss of independence or physical and mental abilities associated with terminal illness often results in social isolation, and research has shown how isolation can exacerbate symptoms of decline and actually hasten death. Graduates of occupational therapy schools can help such individuals adapt to their limitations and retain a degree of independence while introducing them to new and appropriate functions and roles and thereby helping them maintain self-esteem. Moreover, it gives patients regular, personal contact with a compassionate individual at a time when many others turn away, leaving them alone.
Providing therapy to terminally ill patients is perhaps the most emotionally challenging and taxing form of occupational therapy, and some therapists are better able to do this than are others. Getting involved in the lives of patients who are likely to die soon is never easy, and it is important that an occupational therapist be aware that working with such patients can take an emotional toll. A degree of compassionate detachment is vital. Caretakers of terminally ill loved ones, as well as health professionals working in hospice environments, often experience their own psychological difficulties, especially depression, when helping such patients in their final days as well as in the months after their charges have died, studies have shown.
Remember that being enthusiastic and friendly can help energize and motivate such patients who are prone to depression, boredom, and feelings of helplessness. A lack of energy due to the condition and the drugs taken to treat the disease also present obstacles, but enabling patients to regain some control of daily activities and improving their residual physical strength can help improve their mental outlooks.
For practicing graduates of occupational therapy schools working with terminally ill patients, simply providing social contact and normal conversation is viewed as one of the most useful forms of help. Reminiscence therapy—encouraging patients to talk about their lives—has been demonstrated to be a very effective form of mental support.
Salaries for hospice occupational therapists tend to be lower than those of their colleagues working in other areas but typically range between $45,000 and $60,000 per year.
Home Health Care
With the aging of the baby boomer population, in-home occupational therapy is quickly becoming one of the strongest areas of job growth. Many graduates from occupational therapy schools help out at such facilities and are already in on the ground floor. Therapists work to maintain and help restore impaired function through a variety of techniques, but unlike treatment in professional rehabilitation centers, such care does not usually involve more complex equipment or testing. Therefore, most in-home occupational therapy typically works best for individuals with less severe impairments and those who have already spent a certain amount of time at in-patient rehabilitation centers.
As with all forms of occupational therapy, practitioners seek to help individuals maintain strength and become more self-reliant, to return to work, and to participate more fully in other social and recreation activities, all of which serve to improve physical, mental, and emotional well-being. Providing care in a patient’s home allows a less formal environment than in an institutional setting, so a patient tends to be more relaxed, which can be helpful. Most of the techniques used in ongoing rehabilitative care can be taught and performed in the home.
Another advantage is that in-home care gives the therapist a better understanding of the patient’s day-to-day environment. Meeting the client and his or her family members in the home can provide an occupational therapist with valuable information that might not be available when assessing the patient in a more formal health care setting. It can also give the therapist an opportunity to evaluate a client’s needs for special equipment or training appropriate to individual characteristics of the home and economic situation.
Salary.com reported in 2011 that in-home occupational therapists averaged around $67,000 per year, while the Bureau of Labor Statistics reported that their mean annual wage was about $79,000.
School Occupational Therapists
A number of graduates of occupational therapy schools choose to work exclusively with children in elementary and secondary schools. They evaluate each child’s abilities and recommend and provide therapy, typically within a structured and closely monitored environment. Most therapists work with individual children or small groups, but they also consult with teachers and often sit on administrative committees or school board panels dedicated to helping educate children with disabling injuries or illnesses, including both physical and cognitive challenges.
Schools provide occupational therapy to help children more fully benefit from special education programs. Therapeutic strategies often include motor skill enhancement, promoting listening skills, helping them learn to follow directions, and improving their social interactions with other children. They also teach various activities and exercises to encourage a child’s active participation in self-care, academic and vocational pursuits, as well as in play and leisure activities in the school environment.
Occupational therapy is considered a related service to special education programs under the 1990 Americans with Disabilities Act (ADA), which means that such services must enhance or support educational goals. In the school setting, graduates of occupational therapy schools evaluate and try to address specific issues that interfere or impede a child’s educational performance, such as hand function, oral motor function, visual motor and perceptual skills, sensory awareness and processing, and self-care.
The typical caseload for a full-time occupational therapist within a school system is about 30 or 45 students if paired with an occupational therapy assistant. Full-time elementary and secondary school occupational therapists earn, on average, an annual salary of around $61,000.
Job Training Facility and Rehabilitation Counselors
Occupational therapists at vocational training facilities help injured or impaired individuals to return to work or prepare them for a new career that will be more accommodating to their specific physical or mental problems. Certified graduates from occupational therapy schools who work as rehabilitation counselors help individuals with disabilities improve their physical and mental performance and work to help them find employment, usually after an accident or illness that prevents them from returning to their old jobs. At job training facilities, they typically work with physicians, other physical therapists, and psychologists.
Many of these clients are receiving worker’s compensation, and most employers are more than willing to help pay for retraining them for different light-duty jobs within the same company. The federal government also sets aside a considerable sum to help fund occupational rehabilitation of disabled workers.
One aspect of occupational therapy in this setting involves what is called work hardening, which uses graduated work simulation to better assess and address the medical and psychosocial problems of an injured worker. Activities are designed to increase work tolerance, master pain, improve work habits, and increase confidence and proficiency.
Graduates of occupational therapy schools working as rehabilitation counselors identify existing and potential barriers to medical, psychological, personal, social, and vocational abilities then design plans of action to address these. Clients come from a number of sources, including company and private physicians, family members, hospitals, social workers, and employment agencies.
If a client already has a job, the counselor often works with the employer to design workplace modifications and accommodations or helps them find a better-suited job. The client–counselor relationship can be as brief as one week or may take several years depending on the extent of the problem and each client’s needs. Counselors and vocational training occupational therapists earn roughly the same as those in other areas of special expertise; averaging around $70,000 per year.
Adult Day Care and Nursing Homes
Many graduates of occupational therapy schools work with elderly patients, especially those in full-time nursing facilities and adult day care settings, helping these seniors lead more productive, active, rewarding, and independent lives.
Most nursing home patients receive appropriate therapy interventions for their initial medical conditions, and at least two thirds of patients reach their occupational therapy treatment goals, according to a report by the Inspector General’s office of the Department of Health and Human Services (HHS). Most would not have achieved similar levels of function without occupational therapy, the report stated. The HHS reviewers also found that most treatment goals were reached within a reasonable time given each patient’s medical condition, tolerance level, and type of therapy required.
Certified graduates of occupational therapy schools working in nursing homes deal many different factors common among older individuals, especially those recovering from falls or who need help walking. They provide general assistance and recommendations to help patients maintain the basic activities of daily life for as long as possible. Almost all nursing home residents require evaluation by an occupational therapist, usually when they are first admitted, during changes in their health, or after medical emergencies. Instructing residents in the use of adaptive equipment, such as wheelchairs, walkers, and special toilet and bath fixtures, is an important part of this work because it helps increase independence while minimizing discomfort and considerably decreasing the risk of injury.
The salary range for occupational therapists at nursing homes runs from $62,700 to $80,200, but their mean income was $70,600 in 2010.
Like nursing home occupational therapists, those working in adult day care settings spend much time with clients and their families, assessing and addressing issues that are affecting all of them. Because they work in the field, such occupational therapists usually have more flexibility in their schedules than those in full-time occupational therapy staff jobs.
Life Planning Coach
Graduates from occupational therapy schools can also become members of special teams that support a disabled student or worker to function and engage in appropriate future job training. Transitional training services have evolved recently from focusing on disabilities to abilities and a patient’s determination to become self-supporting and independent.
As part of a life planning team, an occupational therapist must have experience in supportive and assistive technology, task analysis, behavior and psychosocial issues, sensory and memory processing, and coordination. Occupational therapists work in collaboration with other team members, sharing resources and insights on each client’s specific abilities and their goals and life plans, collectively steering a course of action designed to help patients become self-sufficient wage earners.
These types of programs promote self-advocacy in school and community forums and provide prevocational training in writing, basic computer skills, and time and money management. Here, therapists work to enhance development of each student’s abilities to function in cooperative work projects, to better organize materials, and to use community transportation.
An important aspect of this also involves assessing a student’s ability to perform specific jobs and helping to facilitate internships. They also help patients develop marketable skills and abilities as well as guiding them through job search and application processes, including helping with résumés, cover letters, and transcripts. Coaching them in social communication and interview skills and working with others is another important part of the job.
Business Ergonomics Consultant
Consulting on ergonomics in the workplace, either full time or part time, can be a lucrative field for graduates from occupational therapy schools. Ergonomic injuries, especially carpal tunnel syndrome and back problems, cost employers many billions of dollars each year in lost productivity and higher health and worker’s compensation insurance premiums.
Most ergonomics programs include establishing prevention and early detection guidelines for workers to avert more severe and chronic medical conditions while also helping employees return to work after injury. Because many recent graduates of occupational therapy schools have expertise in these areas, they can play major roles in developing and implementing workplace ergonomics plans and return-to-work options. They also can identify hazards that contribute to on-the-job injuries and recommend the most appropriate strategies to reduce or eliminate risks.
Occupational therapy consultants can apply their ergonomics expertise in an array of different work environments, ranging from manufacturing facilities to white-collar offices and even hospitals and nursing homes. From suggesting improvements in workstation designs in offices to creating more effective guidelines and policies to reduce physical risks in industrial settings, occupational therapists serve as important consultants across a wide spectrum of jobs.
It is a well-established fact that the longer an injured worker remains off the job, especially due to a back injury, the less likely it becomes that he or she will ever return. Therefore, many occupational therapists work almost exclusively with chronic back injury patients. Occupational therapists are also especially adept at task analysis in repetitive motion injuries, but they are also qualified to help design pre-hire physical screening programs and tests.
Occupational therapists who perform workplace ergonomic evaluations charge from $75 to $250 per hour depending on the location and complexity of the individual workplace and the range of different jobs employees perform.